When should thiopurine treatment be stopped ?

Friday, 15 April 2011 09:03

Clinical News

Thiopurines, and especially azathioprine (AZA) and 6-mercaptopurine (6-MP), remain the treatment of choice for inflammatory bowel diseases (IBD).

 Due to their widely recognized therapeutic efficacy at maintaining clinical remission without use of corticoids, they constitute first-line maintenance treatment in Crohn’s disease (CD) and second-line treatment in ulcerative colitis (UC).

The possibility of interrupting efficient thiopurine treatment remains subject to debate.  While the latest Ecco European recommendations envisage the possibility of stopping treatment after 4 years of remission, most currently available studies show higher risk of relapse following treatment interruption  independently of the duration of remission under treatment.  Indeed, two recent studies showed cumulative risk of relapse of  65% for CD and 65% for UC at  5 years after arrest of treatment.

In young subjects with good treatment tolerance, prolonged administration and regular surveillance would seem to be a satisfactory option.  For patients over the age of 50,  however, increased  risk of lymphoma  means that  interruption of treatment after several years of remission has to be considered.

It should also be noted that, in case of relapse following arrest of AZA, the latter can once again be used in retreatment,  and is generally effective.

References:

Xavier Treton, Yoram Bouhnik HEPATO-GASTRO et Oncologie digestive vol. 17 no 6, november-december 2010